Provider Demographics
NPI:1326114869
Name:EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC
Entity Type:Organization
Organization Name:EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:1620 N MESA
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3595
Mailing Address - Country:US
Mailing Address - Phone:915-545-5300
Mailing Address - Fax:915-532-1413
Practice Address - Street 1:1620 N MESA
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3595
Practice Address - Country:US
Practice Address - Phone:915-545-5300
Practice Address - Fax:915-532-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008549261QA1903X
261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008549OtherSTATE CERTIFICATION
TX008549OtherSTATE CERTIFICATION